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Mind, Body and Sport: Suicidal tendencies

An excerpt from the Sport Science Institute’s guide to understanding and supporting student-athlete mental wellness

By David Lester

While there’s no “good” news when it comes to suicide, the silver lining at least is that it is not especially common in undergraduate college and university students. Some studies report suicide rates that are lower than young people of the same age who are not in college, and some studies report similar suicide rates for the two groups.

As a result, when we turn to college student-athletes, there are very few cases of completed suicide. However, we do know what kinds of factors and stressors might lead to an attempted suicide, and we do know that participation in sports can actually protect against some of those stressors.

At the present time, student-athletes appear to be less likely to have suicidal ideation and to make suicide attempts than other college students, but the protective impact of sports varies with the type of sport, sex and ethnicity. The protective effect is most evident in white male student-athletes playing in traditionally “male” sports.

For amateur athletes, researchers have focused on suicidal ideation and attempted suicide, and most of the research has been conducted on high school athletes. The Centers for Disease Control and Prevention have conducted a Youth Risk Behavior Surveillance of high school students every two years from 1991 to 2011.

Of those studies, eight showed a protective effect for boys while three showed no effect. For girls, six studies showed a protective effect, one a detrimental effect, and four no effect. The protective impact of sports on suicidal ideation and attempts was, therefore, more evident for boys than for girls.

There also seemed to be an impact of ethnicity, with the protective effects more evident for white boys than for boys of other ethnicities.

We can only speculate about the reason why participation in sports generally finds a protective impact for suicidal behavior in most studies. First, participation in sports involves physical activity, and exercise may reduce depression. Second, participation in sports has many positive side effects, including the social bonding from being in a team and the increase in self-esteem from achieving success in the sport.

On the other hand, participation in some sports may increase the likelihood of hazing (especially of rookies), alcohol abuse, risky sexual behavior and violence. Since the limited research indicates a protective impact from sports participation, it would appear that the positive effects outweigh the negative ones.

A recent study reported that the protective impact of sports was found for some team sports, but that participation in a sports activity not generally engaged in by those of one’s own sex is detrimental. For example, boys who were cheerleaders and girls who were wrestlers more often reported suicidal ideation. The study also found that the protective effects of sports participation were not as clear in African-American, Hispanic-American and Asian-American students.

Some studies have been conducted recently that explore suicide in professional athletes and the risk factors that predict these suicides. Many of these factors may apply to the student-athlete population as well.

Anabolic-Androgenic steroids. Professional athletes’ anabolic-androgenic steroid use has been clearly documented in recent years, and research has found that it increases the risk of both suicide and outwardly directed violence such as assault and murder. One study of power lifters in Finland found that 38 percent of the deaths of power lifters who used steroids were from suicide as compared with only 3 percent of the deaths of Finnish men in general.

Concussions. Concern about the role that concussions (mild traumatic brain injury) in sports play in athletes has increased, especially with the revelation that some former professional football players have developed chronic traumatic encephalopathy (CTE). Although depression is more common in professional football players who have suffered with multiple concussions, there is no clear relationship that has been described in collegiate football players. Suicide has occurred in professional football players who developed CTE, but the causal relationship between CTE and concussion is unknown, and the relationship – if any – of suicide and CTE is also unknown.

Drug abuse and alcoholism. Both are common in professional athletes, and college student-athletes, as noted in the prior article “Substance Use and Abuse,” are also at risk for these issues. Substance abuse of any kind is a risk factor for suicide.

Psychiatric problems. Many professional and collegiate athletes have psychiatric symptoms, some of which predate their involvement in athletics and some of which are exacerbated by their sports careers. Psychiatric problems are another major risk factor for suicide.

Bullying and sexual abuse. Some studies indicate that up to 10 percent of Olympic athletes endured bullying and sexual abuse as children and adolescents, often as part of their sports involvement. In recent years, several coaches have been found guilty of sexually abusing players, and hazing and bullying, especially of rookies, are part of the culture of sports. Again, these experiences are important risk factors for suicide.

Retirement. Retirement is perhaps the most important risk factor for suicide in professional athletes. Studies of baseball players and cricket players who died by suicide found that very few professional athletes died by suicide during their careers. Most killed themselves after their careers were ended either by injury, being fired or retiring. Many professional athletes have made no plans for their lives after their careers are over and when they are no longer in the spotlight. They may have pain and physical impairment from the injuries that they received during their careers, and they may face serious financial problems once their income ends, especially if they have incurred expensive long-term costs (such as alimony and child support) and if they spent their wealth unwisely during their professional careers.

Given all of these risk factors, how common is suicide in professional athletes? A 2013 study found that, after controlling for age and sex, those currently listing their occupation as athletes did not have a higher risk of suicide, although they did have a higher risk of death from all violent causes (suicide, accidents and murder). In baseball, 1 percent of deceased players are documented to have died from suicide, less than expected for men in the United States. And for cricket in Great Britain, a 2001 study found that 1.5 percent of deaths were from suicide, again not especially high. Most of these suicides occurred in players no longer active in the sport.

Clearly, much more research is needed on this important topic to identify the reliable associations regarding suicide and suicidal ideation, and the causal mechanisms underlying these associations.

David Lester is a distinguished professor of psychology at the Richard Stockton College of New Jersey. He is a former president of the International Association for Suicide Prevention. Lester has published extensively on suicide, including “Understanding and Preventing College Student Suicide” (Charles C. Thomas, 2011) and “Suicide in Professional and Amateur Athletes” (Charles C. Thomas 2012).

A sudden lift in spirits after extreme depression (this can mean a person is relieved that problems will “soon be ended”)

Having a plan

Myths about suicide

People who talk about suicide do not commit suicide.

Mentioning the word “suicide” may give a person the idea.

All suicidal people are mentally ill.

A suicide threat is just a bid for attention and should not be taken seriously.

Suicide happens without warning.

If a person attempts suicide and survives, he/she will never attempt again.

Once a person is suicidal, he/she is suicidal forever.

What can you do?

When dealing with a student-athlete who has expressed, indicated an intent or plan, or attempted suicide, do not attempt to determine the seriousness of the thought, gesture or attempt. Such thoughts, behavior or threats are serious and potentially dangerous. Do not assume the person is engaging in suicidal thoughts or actions merely for attention.

Make an immediate referral to a mental health professional who can immediately evaluate the student-athlete. Most college campuses have a counseling center staff member who can offer guidance or referral. Many counseling centers will offer “walk-in” or “emergency” services. For emergency situations after normal office hours, the counseling center staff can recommend other options, such as going to the nearest hospital emergency room.

Your quick response lets a student-athlete know that you take his or her health difficulties and life seriously; it is better to err on the side of responding immediately and in a supportive manner.

Have the names and phone numbers of referral sources available. Determine your options now before you need them.

Make sure a suicidal student-athlete is not left alone. The student-athlete should have someone with him or her until a mental health evaluation is completed.

Questions for reflection

Do you have the names and phone number of referral sources easily available?

Have you discussed the “myths” regarding suicide with your mental health team?